NPI 1104428473

Michael Jackson

Practitioner Driver Byram, MS

Practice location

Address: 252 Charlene Dr, Byram, MS 39272-6418
Phone: (601) 278-2435

Registered specialties

Driver Primary

Other Service Providers Taxonomy 172A00000X Licence 800105022 (MS)

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Registry record

NPI: 1104428473
Entity type: Individual
Sex (as registered): Male
NPI issued: 12 Nov 2020
Record last updated: 12 Nov 2020

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.